The review dedicated to the role of D-dimer in diagnostics of venous thromboembolism (VTE) in elderly patients with D-dimer levels increasing with advancing age especially in the presence of concomitant diseases. This leads to a high proportion of elderly patients with D-dimer levels higher than conventional cut-off values for VTE exclusion. This in turn results in the decrease of D-dimer specificity for VTE exclusion in elderly patients from 60% for patients of 51—60 years to 10—15% in patients older than 80 years and having low risk of VTE. That is why, for elderly patients there is a rise of false positive diagnosis of VTE and the number of prescribed of imaging testing (CT-angiography, duplex ultrasound). Typically less than 20% of elderly patients have confirmed VTE diagnosis. For the patients aged over 50 years an age-adjusted D-dimer cut-off value, calculating as [age (years) × 10 µg/l or ng/ml] has been proposed to exclude VTE. The results of the studies dedicated to the use of diagnostic strategy including clinical probability assessment and aged-adjusted D-dimer cut-off for evaluation of elderly patients with suspected VTE. The application of this algorithm substantially increases usefulness of D-dimer test for DVT exclusion in elderly patients, especially if older than 80, because this algorithm: 1) increases specificity of testing without changing its sensitivity; 2) reduce the number of false positive diagnoses by 30% without substantial increase of false negative diagnoses; 3) allows to avoid correctly imaging examinations in 30—54% of elderly patients with non-high clinical probability of VTE.